Abstract
Introduction
A case of trigeminal neuralgia is described in which the initial attack was so unexpected and abruptly painful that the patient's first thought was that she had been the victim of a stray gunshot. Subsequently, her practice of covering her face in outdoor public places to prevent wind from triggering the pain aroused anxiety among onlookers. In both instances increased awareness of terrorist events internationally may have influenced the psychological reaction to a painful syndrome.
Case report
‘I've been shot in the face’, thought the middle-aged woman driving to work. Gripping the steering wheel and barely managing to keep her vehicle on the road, she glanced to her right, expecting to find the seat covered with shards of shattered glass. But the seat was clear, the window intact.
A group of shoppers shrank back as a woman stepped through the gusty doorway and entered the mall just weeks after 11 September 2001. A black balaclava hooded mask hid all but her eyes as she silently made her way through the crowd. Children pointed. Alarmed, their parents whispered and adjusted direction. The strangely dressed figure never showed her face.
These two cases are one and the same patient. Her first attack of trigeminal neuralgia occurred while driving, with the abruptness of a gunshot and with piercing intensity. Over the years she went on to experience recurrent paroxysms of excruciating dagger-like facial pain so agonizing that the slightest touch to the face instantly incapacitated her. In fact, exposure to cold wind was so unbearable that on blustery days she could not leave home unless she wrapped her face. Whereas a scarf tended to brush against the cheek and trigger pain, she found that a neoprene hood sculpted tightly to her face effectively blocked the wind. Once in place, the hood prevented pain, but removing and reapplying it was exquisitely painful. Thus she preferred to leave it on while shopping, knowing that she would soon face the wind again when walking to her car. She commented that the experience in the shopping mall made her feel compassion for women of other cultures living in the United States who, for religious reasons, traditionally cover their faces.
Just as episodic acts of terrorism can hurl society into a state of fear and anticipation, so do many patients with trigeminal neuralgia live each day dreading the possibility of the unpredictable return of sudden severe facial pain. A single nerve holds the whole mind hostage, and safety from another assault of pain is never certain.